These are predominantly used for cutting sutures. Our technique involves placing a cotton-tipped applicator under the artery and lifting it to partially occlude flow within the vessel as an additional suture is placed at the leakage site to complete the revision. According to the protocol, the participants practiced the technique of end-to-end anastomosis on silastic tubes (Biomet) for 24 consecutive sessions held at 1:00 pm every other day. Severe arterial intimal dissections were observed in 9 (6.9%) of 130 arterial microvascular anastomoses in free flap reconstruction for oral cancer patients from January 2013 to December 2013. Plast Reconstr Surg. The Use of Arteriovenous Anastomosis for Replantation of the Distal Phalanx of the Fingers. Spatulated versus end-to-end anastomosis for small vessel injury. The technique of microvascular anastomosis can also be reproduced using human or bovine placentas [9]. Since this time, a wide range of methods have been proposed for coapt- ing microvessels, and these are still evolving today. The vessels are illuminated with a laser, and the fluorescence is picked up by a charged couple device video camera. A comparative study was undertaken to evaluate a new microvascular anastomosis technique utilizing only four sutures placed 90 degrees apart and sealed with fibrin glue, in contrast to the conventional method of eight sutures as a control. However, in case of vascular injury and various microsurgical reconstructive procedures a safe anastomosis is essential. Comparison of continuous and interrupted suture techniques in microvascular end-to-side anastomosis. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and carotid arteries and complex cerebral aneurysms and even during resection of brain tumors that obstruct major cerebral arteries. Early microsurgical reconstruction of complex trauma of the extremities. 2001;26:530–9. We performed the classic interrupted suture anastomosis technique in group 1 (n = 15) and our new technique, using 3 horizontal mattress sutures, in group 2 (n = 15). In our experimental study of a new microvascular anastomosis technique, we divided 30 Wistar albino rats into 2 groups. We used this technique in 6 of the 9 patients. CrossRef Google Scholar. This branch is then dissected free, cut distally, and moved towards the adjacent 1-2 mm … This article will review the various techniques of microvascular anastomosis used in head and neck reconstruction and analyze the newer techniques and methods employed today. This paper reports a method for microvascular anastomosis suturing, using foam rubber cylindrical mandrel, which helps to solve the above-stated problems. Author information: (1)Plastic Surgery Research Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Mihai A. Constantinescu MD. The most recent review of suture techniques in microvascular anastomosis shows that a statement cannot be made to favor either technique’s patency rate and/or ease of performance when comparing end-to-end and end-to-side configurations, mainly because there is no study in humans 6. This section addresses the development of microsurgical suture technique for microvascular anastomosis, and continues to present the array of non-suture methods currently proposed as alternatives to standard suturing. STUDY DESIGN: Cylinder stents of 1 mm diameter and 5 mm length were fabricated using N-fibroin from silkworms. The main challenge to a successfully patent anastomosis is intimal interposition during the standardized microvascular suturing. The hand-sewn anastomosis, which is the most commonly used technique for constructing a spliced vein conduit, can be technically challenging and time consuming. 01:37 Exposure. 05:32 Posterior wall. Keywords Microvascular Microarterial Anastomosis Microsurgery Suture Coupling Ring-pin Clips Adhesives Gels Stents Laser Magnets This is a preview of … 00:06 TECHNIQUE OVERVIEW. Wei FC, Tay SK. A straight pair of microsurgical scissors with sharp narrow tips and a spring-loaded handle. Sixteen anastomoses were performed in both radial arteries and cephalic veins in eight dogs. RESULTS: Stent anastomosis was successful in 21 (96%) rats. This technique is of first choice when we cannot properly manipulate both the vessels of the microvascular anastomosis, we cannot manage to rotate it in order to carry out the suture of the posterior wall. In 22 rats, aortas were dissected, and the stent was inserted into the two ends of the aorta and fixed using methylmethacrylate. Arterial anastomosis. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. CrossRef Google Scholar. O'Neill AC(1), Winograd JM, Zeballos JL, Johnson TS, Randolph MA, Bujold KE, Kochevar IE, Redmond RW. Comparison of continuous and interrupted suture techniques in microvascular end-to-side anastomosis. Curved/Adventitia Scissors. Technical errors during arteriotomy pose a significant challenge for the microsurgical technique, making the end-to-side anastomosis prone to failure. When performing the one-way-up technique, we begin suturing the posterior side. Introduction: The biomechanical properties of small vessels and microvascular anastomoses have not been studied completely yet. BACKGROUND AND OBJECTIVES: Photochemical tissue bonding … Microsurgical arterial end-to-end anastomosis; basic technique Microsurgical technique return to:Microvascular Surgery Protocols. Donor and recipient vascular structures, tobacco usage, and personal experience of the surgeon are other important factors. This section addresses the development of microsurgical suture technique for microvascular anastomosis, and continues to present the array of non-suture methods currently proposed as alternatives to standard suturing. Technique description. 9. These have a curved blade and sharp tips. The success of microvascular surgery depends on many technical factors such as instruments, sutures and the technique of anastomosis. We compared 3 end-to-end suturing techniques for microvascular anastomosis: interrupted suturing, continuous suturing, and a 2-octyl-cyanoacrylate–based lid technique using an umbilical artery model. For microvascular anastomosis, this technique requires fishmouth incisions at both vessel ends and the completion of four sutures. We dealt with an artery exhibiting severe intimal dissection by using a new suture technique: the intimal sleeve fold-over technique. Institute of Applied Physics, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland. The two methods were compared in regard to patency rates, time needed for vascular anastomosis, and microscopic evaluation. 1979;64:673–82. They were also asked not to refer to didactic sources about microvascular anastomosis throughout the study. microvascular anastomosis: anastomosis of very small blood vessels performed under a surgical microscope. The tools necessary to perform the microvascular anastomosis are few in number but highly specialized in nature: Straight Scissors . Specialized training is essential for mastering the anastomosis of small vessels. Revascularization using microvascular anastomosis techniques has shown utility in a variety of disease states, particularly those concerning cerebral hemodynamic instability and perfusion defects. The side-to-side in situ anastomosis for intracranial-to-intracranial (IC-IC) bypass is one of the recent generation microsurgical approaches in vascular neurosurgery that utilizes 2 parallel arterial segments located in close proximity to revascularize distal arterial territories. Search for more papers by this author. OBJECTIVE: To evaluate a novel microvascular anastomosis technique using N-fibroin stents. It also attempts to provide a brief gist of the various free flaps used in head and neck reconstruction and the ones most expedient in the surgeons' arsenal. Indocyanine green (ICG) is injected into a peripheral vein. VIDEOS PENDING RETRIEVAL. Early microsurgical reconstruction of complex trauma of the extremities. MICROVASCULAR ANASTOMOSIS TECHNIQUE Ottie van Zyl, Johan Fagan This chapter describes the surgical techni-que of microvascular anastomosis, and the management of patients undergoing vascu-larrised free tissue transfer reconstruction of the head and neck. Training in microvascular surgery became even more difficult with less case exposure and growth of the use of endovascular techniques. A new technique for microvascular anastomosis: eversion with 3 horizontal mattress sutures. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. Beat Ott PhD. 8-0 or 9-0 Nylon depending on the size and thickness of the vessels; Back wall first, then front wall 8. Arterial anastomosis (end-to-end) Fibula free flap: peroneal artery to facial artery, 9-0 nylon, N. Pagedar & J. Hill, 2009. We assessed the subjective difficulty of the suturing technique, the time needed to perform the procedure, and the flow rate and leakage of the vessel after each technique. Microvascular anastomosis using a photochemical tissue bonding technique. Human placenta anastomosis model includes cleaning of the fetal surface of the placenta, isolation of a second, or thirdorder arterial branch of 2-3 mm in diameter and more than 30 mm in length. J Hand Surg Am. Intraluminal laser light source and external solder: In vivo evaluation of a new technique for microvascular anastomosis. This paper describes a new technique for microvascular anastomosis, which involves the overlapping of the adventitias of the two ends of a severed blood vessel, and then painting a cyanoacrylate adhesive on the outer surface of the vessel around the anastomosed part. Godina M. Preferential use of end–to–side arterial anastomoses in free flap transfers. . Microsurgery is a general term for surgery requiring an operating microscope.The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Orak I, Güneren E, Yildiz L. Ann Plast Surg, 57(1):80-83, 01 Jul 2006 Cited by: 5 articles | PMID: 16799314. Suturing of microvascular anastomosis is still a time-consuming procedure, despite the fact that different techniques and devices were designed to reduce the operation time and increase the patency rate. During living donor liver transplantation, microsurgical techniques in arterial reconstruction greatly reduce the incidence of hepatic artery thrombosis. OBJECTIVE: The microvascular anastomosis (MA) technique remains an important aspect of modern neurosurgical practice. 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